Appendix 55–1. Core parent training topics
What is behavior therapy/parent training?
Why is this the treatment of choice for childhood behavior problems?
If treatment is targeted toward parents of children with a
specific disorder (e.g., attention-deficit/hyperactivity
disorder, conduct disorder), provide information regarding core
symptoms, diagnostic criteria, etiology, and empirically supported
Parent-child coercive interaction cycles: negative behaviors
on the part of both parent and child are reinforced and perpetuated.
Antecedent-Behavior-Consequence (A-B-C) model: modifying behavior
by altering either the antecedents (i.e.,
the way in which the situation is set up) or consequences (i.e.,
rewards or punishments) of any given behavior.
Attending and ignoring
Using attending skills during child-directed special
time, with goal of improving parent-child relationship:
actively attends to child's behavior by narrating activity
in a nondirective, noncoercive, and neutral manner (without interrupting
or making suggestions).
Expanding on attending during special time by differentially
attending to positive and negative behaviors:
to and praising positive behavior.
mild negative behavior.
Delivering praise, rewards, or other positive reinforcement
for positive behaviors that often are ignored, as they are less
salient to parents than are negative behaviors.
Effective vs. ineffective praise; examples of important aspects
of effective praise include the following:
like the way you followed my instruction," rather than "Nice
follows positive target behavior each and every time it occurs.
by negative affect on the part of the parent.
Need for consistency (and immediacy) in delivering praise
or positive reinforcement.
Developing a reward menu with child's assistance
that provides multiple options, such as token prizes or activities
that can be paired with verbal praise.
Token economy/point system
Child earns tokens, points, or privileges for positive
behavior at home that then can be cashed in for rewards such as
small toys, stickers, or valued activities.
lists of daily and weekly rewards.
clearly observable and specific target behaviors that include both difficult
and relatively easy tasks in order to ensure that the child earns rewards
and remains motivated.
points or token values to each behavior (behaviors can all earn
the same number of points or can be weighted by importance or difficulty
or token costs for each reward based on the total number of points
or tokens that the child can earn in any given day and week.
Use reward menu from list of daily and weekly rewards.
Giving effective instructions
Effective vs. ineffective instructions; effective instructions
involve the following:
the child's attention.
the command brief, specific, and framed as what the child should
do (vs. what he or she should not do).
commands as statements rather than questions or "let's" statements.
the child time (up to 10 seconds) to respond.
praise if the child complies or implementing a consequence if the
child does not comply.
Need for attention to phrasing and consistency.
Time-out from positive reinforcement or enjoyable activity
as a consequence for two or three specific target negative behaviors
(such as noncompliance with commands or rule violations such as
physical aggression or destruction of property).
Discussion and troubleshooting of parents' past experience
Mechanics of three-step procedure (see Figure 55–3),
including the following:
seconds for the child to comply (counting aloud can improve compliance).
child does not comply, issue a warning (e.g., "I've
asked you to pick up your shoes. If you do not pick up your shoes
now, you will earn a 5-minute time-out").
child does not comply, inform the child that he or she has earned
a time-out and should proceed directly to the prespecified time-out
serve minimum time in time-out and is only permitted to leave time-out
if he or she has served the last moment or two of the time-out appropriately;
avoid reinforcing negative behavior by approaching or engaging with
the child in time-out when he or she is displaying disruptive behavior.
child must complete original instruction following release from
time-out; if child resists, time-out cycle should be repeated until
child follows through on instruction in order to ensure that he
or she does not use time-out to avoid following parental directions.
violations, no warning is necessary prior to assigning time-out
(as long as parent has discussed this with child in advance).
Specific logistical issues:
Location for time-out: safe, easily monitored,
no potential for positive reinforcement.
Duration of time-out may vary according to child's
age (e.g., 1 minute for each year) or type of time-out procedure
parents have chosen.
Behaviors that earn time-out.
Removal of tokens, points, or privileges when child
displays target negative behaviors.
Can be done in several ways:
token economy system.
Can provide prespecified number of tokens/points
at the beginning of day or week and then assess a fine each time
the behavior occurs (i.e., subtract fined tokens from the initial
Can directly fine child tokens or points he or
she has already earned.
Can add a separate line to the token economy
for rule infractions and then total points earned minus points lost
at the end of the week.
from token economy system: Parents can take away privileges, activities,
Parents should continue to frame the token economy system
in a positive manner to the child even after adding a response-cost
component and also ensure that the child continues to earn rewards
even if tokens are being subtracted for negative behavior.
Developing a plan for homework
Increasing structure for homework time by making rules
explicit and planning ahead for potential problems:
necessary materials are available.
assignment system so that parents are aware of work needing to be completed.
a location for homework that is free of distractions.
a consistent time for homework (or designating a "homework
hour," during which time child must engage in quiet activities
even if schoolwork is completed).
Discussing with parents what their role or level of involvement
in homework should be.
Extending the token economy to the homework time, with tokens
earned and lost for specific homework-related behaviors.
Home-school report cards
Teaching parents to work collaboratively with teachers
in developing and implementing a daily behavior report card that
targets between one and four specific school-based problem behaviors.
Parents provide the child with rewards at home for positive
behavior at school.
Teacher involvement can vary in time commitment or intensity;
teachers may track the precise number of times a problem behavior
occurs or provide a Likert rating of how well the child is doing
on each target over the course of the school day.
Managing behavior in public places
Employing the A-B-C model before entering the public
place in order to minimize possible problem behavior.
Anticipating potential problems and restructuring antecedents
Setting expectations for behavior and conveying these to the
child in advance.
Having preplanned consequences in place and communicating
these to the child in advance.
Rewarding positive behavior.
Assigning consequences (e.g., modified time-out) for negative
Rule" (Premack contingencies)
Using more desirable activities as reinforcers for
completion of less desirable activities: "When/if
you do what I want you to do, then you
do what you want to do"; for example, parents using this
strategy might tell their child, "When you finish your
homework, then you can watch TV."
Planning ahead/anticipating future behavior
Reviewing strategies learned to date.
Applying the A-B-C model to new problems.
Troubleshooting existing interventions: making sure rewards
are motivating for the child, interventions are manageable in size
for both child and parents, and reward and punishment (e.g., time-out,
response cost) procedures are being implemented consistently.